Comparison of Remifentanil With Fentanyl for Deep Sedation in Oral Surgery

The aim of this study was to compare recovery for oral surgery patients given a deep sedation regimen of midazolam, propofol, and remifentanil with a standard control of fentanyl in place of remifentanil. This investigation was designed as a randomized, prospective, single-blinded controlled study. Group 1, the control, received midazolam 0.03 mg/kg, fentanyl 1 μg/kg, and propofol initially at 140 μg/kg/min. Group 2 received midazolam 0.03 mg/kg, remifentanil: propofol (1:500) given at an initial propofol infusion rate of 40 μg/kg/min. Outcome measures included time to response to verbal command, Aldrete score = 9, Postanesthesia Discharge Scoring System = 7, and assessment by the Digit Symbol Substitution Test. Forty-seven subjects were entered in the study. Baseline findings were homogenous between the 2 groups. Subjects in group 2 recovered earlier ( P < .005) and required less propofol for both the induction (0.8 ± 0.4 versus 1.2 ± 0.6 mg/kg; mean ± SD, P < .01) and maintenance of deep sedation (46 ± 9 versus 131 ± 17 μg/kg/min; P < .005). There were minor differences in vital signs. This study demonstrated that this remifentanil regimen provided significantly more rapid recovery and used significantly less propofol compared with the fentanyl regimen.